{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CINDY A PUGH","gend":1,"add":"2627 BUCK ISLAND ROAD","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-7633","dob":"1964-08-21","age":"","mstatus":"","insh":11004321,"cliId":"9DX3C39AA97","pno":4342965293,"cno":4342965293,"email":"","ename":"","eno":"","pphy":"JAMES D ALLER MD  ","ppno":4349715959,"pcpadd":"908 E JEFFERSON ST,STE G1","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":229025375,"pcpcounty":"","pcpid":"P9476160","pcpname":"JAMES D ALLER MD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"2631 BUCK ISLAND ROAD","add3":"","madd1":"2627 BUCK ISLAND ROAD","madd2":"2631 BUCK ISLAND ROAD","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22902-7633","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Q90.0","F80.9","H61.23","L30.9","E78.2","N18.9","Q90.9","E03.9","Z00.00","R10.9","R63.4","E55.9","E53.8","D75.89","H90.5","D18.01","Z12.31","Z80.8","Z80.49","E86.0","R19.7","R68.83","D69.6","N28.9","L21.9","L71.9","R13.13","E04.2","E66.9","Z79.899","S93.401A","M25.571","X50.1XXA","W18.49XA","S99.911A","S99.921A","M79.89","M79.671","S93.491A","S93.621A","Z23","E78.5","Z11.59","Z13.31","Z12.11"],"date":["2020-03-11","2020-03-11","2020-02-07","2020-02-07","2021-09-20","2019-02-08","2020-03-02","2021-09-20","2021-09-20","2020-03-02","2020-05-11","2020-03-02","2020-05-11","2020-03-02","2019-03-13","2019-04-01","2021-10-07","2021-10-07","2021-10-07","2019-04-22","2019-04-22","2019-04-22","2019-04-24","2019-04-24","2020-05-11","2021-09-20","2018-08-08","2018-08-08","2018-08-08","2018-08-08","2018-09-16","2020-09-23","2018-09-16","2018-09-16","2018-09-16","2018-09-16","2018-09-16","2020-09-23","2020-09-23","2020-09-23","2019-11-08","2019-12-05","2021-09-20","2021-09-20","2021-09-20"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","70377002711","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","33342032815","TRIAMCINOLON","CRE 0.005","","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","59762374401","CLINDAMYCIN","LOT 10MG\/ML","","Select","Select",""],["","378180510","LEVOTHYROXIN","TAB 75MCG","","Select","Select",""],["","68462025217","DESONIDE","CRE 0.0005","","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","33342032815","TRIAMCINOLON ","CRE 0.005","90","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","90","Select","Select",""],["","59762374401","CLINDAMYCIN ","LOT 10MG\/ML","60","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","378180510","LEVOTHYROXIN ","TAB 75MCG","90","Select","Select",""],["","68462025217","DESONIDE ","CRE 0.0005","30","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","10","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","66993096045","METRONIDAZOL","0.75%","45","Select","Select",""],["","66993096045","METRONIDAZOL ","CRE 0.0075","45","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}